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St Rose Hospital Town Hall
Safety Hospital Strategy, Summer 2012
The data shown here reflects only Alameda County residents who visited these facilities. Utilization will be lower
than what a facility reports to the state on total patient volume.
Kaiser Fremont is not reported by OSHPD as a licensed facility so they are combined with Kaiser Hayward
Alameda County
Health Care
Services Agency
St Rose Hospital is an The County has provided significant support to St Rose
Independent Disproportionate Hospital over many years, including more than 40 million in
Share Hospital in Hayward. the last five years of general operating subsidies.
Multiple Health System Partners have also supported
St Rose , Specifically through the creation of the St
St Rose is a critical safety Rose Emergency Fund (7 million, established 2009)
net provider of general acute and 12.5 million in stabilization funding over the last 8
months.
care for central and southern
Alameda County. St Rose’s Fiscal and Operational Challenges have been
well documented and discussed by The Alameda County
30,0000 ED Visits
Board of Supervisors at multiple Health Committee
15% of indigent Inpatient Care presentations, and in recent actions by the BOS and
40% MediCal Inpatient other health system stakeholders.
The Problem
• There is simply not now, nor will there be in the foreseeable
future, an adequate supply of Primary and Preventative Care.
• Health Care costs are rising at five times the rate of wages,
with health care premiums doubling in the last decade and
projected to at least double in the next decade.
• A significant part of the problem is that we continue to drive
episodic care to the highest cost settings.
• The General Acute Care system in Alameda County relies on
public sector subsidies for the handful of safety net hospitals
that serve he majority of the under and uninsured.
The Problem (cont.)
• Per the American College of Emergency Room
Physicians, California ranks 51st among states in the US
in terms of ED capacity.
• In all other jurisdictions that expanded coverage
(Vermont and Massachusetts), there were significant
increases in ED utilization after coverage expansion.
• Safety net providers, particularly general acute care
providers have to look at competition in a post reform
health care economy.
• Safety net hospitals must forge new alliances and
converge their operating models to leverage
supplemental payments, and operating efficiencies.
ACMC 71,291
Kaiser Hayward 68,388
Emergency Washington 45,169
Department
Visits: Kaiser Oakland 43,350
Children's
Alameda County
38,074
Acute Care ABSMC-Hawthorne 36,124
Facilities, 2010 St. Rose 32,804
(N=457,582) Eden 30,765
ABSMC-AB 30,440
San Leandro 24,730
Valleycare 23,497
Alameda 12,950
0 20,000 40,000 60,000 80,000
Number Visits
ACMC 66.5
Alameda 35.2
Emergency St. Rose 24.5
Department Total AC Acute Care 23.5
Visits: Eden 19.9
ABSMC-Hawthorne 19.6
Estimated
Percentage
ABSMC-AB 17.5
Uninsured
Washington 17.3
San Leandro 16.3
2010 Valleycare 14.1
Children's 11.7
Kaiser Oakland 8.6
Kaiser Hayward 6.6
0 20 40 60 80
Percentage
Emergency Department Payer Source:
Alameda County Acute Care Facilities, 2010
Children's
St. Rose
Washington
ABSMC-Hawthorne
ABSMC-AB
Eden
ACMC
Valleycare
San Leandro
Alameda
Kaiser Hayward
Kaiser Oakland
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
MediCal NonFed/Indigent Self-Pay Private Other Medicare
Who Goes Where?
The Affordable Care Act Will Add More Than 200,000
Covered Individuals in Alameda County
Employer and
MediCaid Expansion The Exchange Individual Mandate
0% FPL 133% FPL 400% FPL
56,000 newly eligible 107,000 eligible for subsidy 35,000 required to
purchase or their
employer will be required
to purchase
Approximately 60,000 Alameda County Residents
will not be insured, even under the most optimistic
implementation scenario
ACMC 26.2
St. Rose 8.6
Total AC Acute Care 5.9
Inpatient Visits: Eden 5.5
Estimated San Leandro 5.4
Percentage Alameda 4.3
Uninsured 2010 ABSMC-Hawthorne 4.0
Washington 3.2
ABSMC-AB 2.5
Valleycare 2.4
Kaiser Oakland 1.7
Kaiser Hayward 1.3
Children's 0.8
0 10 20 30
Percentage
Inpatient Visit Payer Source:
Alameda County Acute Care Facilities, 2010
ACMC
Children's
St. Rose
ABSMC-AB
Eden
Valleycare
San Leandro
ABSMC-Hawthorne
Alameda
Washington
Kaiser Hayward
Kaiser Oakland
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Medi-Cal Indigent Self-Pay Private Other Medicare
ED Overload & Critical Patient Overload
500
450 434
Number of Diversion Occurrences
400
350
300
ED
250 224
CPO
200 175
144 137
150
100 87
55
50 39
14 6 5 3 12
0
Summit
Highland
San Leandro
Eden
St. Rose
>30%
20 - 29.9%
10 - 19.9%
>1.5% CR (48 – 72 visits)
1 – 1.5% CR (32 – 48 visits)
County Rate (CR) = 32.08 ED visits / 100 persons
> 1.5 times the CR (6-10.5 avoidable visits/100)
> 1-1.5 times the CR (4-6 avoidable visit/100 )
County Rate (CR) = 4 avoidable ED visits / 100 people
Take Away
• Safety Net Hospital face real and significant revenue
challenges.
• The loss of additional general acute care facilities and
their 911 receiving centers will comprise our county’s
health care delivery system, in particular those
communities with the most serious access shortages.
• Safety Net Hospitals, particularly the designated public
and non designate public systems, must seek new
and converged operating structures to promote
efficiencies and leverage supplemental payment
mechanisms.
Current Status of Safety Net
Partnership Strategy
• Children’s Hospital and Research Center
Oakland (CHRCO) and UCSF have signalled
intent to merge.
• Alameda Hospital has secured licensing for
SNF: long term affiliation potential still unclear.
• SLH Hospital in Negotiations with Eden, Sutter,
and ACMC
• SRH in Negotiations with ACMC and Private
Operator
• ACMC ATR on Schedule, short term revenue
picture strong.
Alameda County
Health Care Services
Agency
Three Time Lines:
1) Where we have been: February to August 2012 (now)
2) Where we are going in the short term: August 2012 to
January 2013 (next six months)
3) Where we are going over the next 18 months: January 2013
to February 2014 (18 months and ongoing)
Alameda County
Health Care Services
Agency
Stabilization Period Partners: 3/1/12 to 7/30/12
Washington Township Hospital District: 2 million (1 million match secured)
Cal Mortgage Bond Fund: 2 million (Began 2/28 at 350k a month)
Alameda County Board of Supervisors: 2 million (1 million match secured)
Managed Care Contract Enhancements : 2 million (secured)
CMAC Distressed Hospital Fund: 2.25 million (secured)
Kaiser Community Benefit Program: (3.5 million still under consideration)
TOTAL: 12.25 Million (3.5 million plus 1.75 million match pending)
CMAC Insured Line of Credit: 4 million
Note: 7.5 million of the above commitments are eligible for federal matching funds
via Intergovernmental Transfer. Will generate and additional 3.75 in FFP, bringing
total to 17.5 million.
St Rose Hospital Transitional
Authority August 2012
FEBRUARY 2012
2/28 Cal
3/22
2/7 BOS Mortgage To 7/30/12 JPA Meeting
CMAC
Approves Approves
Approves
funding 2 million
2.25
for CTO bond fund
Million
release
2/22 LOI 4/24 AC BOS
3/13 AC BOS Stabilization and Evaluation
Executed: Approves JPA
Considers 180 days or less for WTHD to complete fiscal and
WTHD
Negotiations and operational due diligence.
Approves 2
approves 2 million
Million
Initial Agreements and Price Waterhouse
Ongoing Operations
Letters of Intent Assessment
Ongoing Operations:
The purpose of an agreement for the county could be:
Emergency Infusion - Secure and Distribute Funding for St. Rose
LOC for 4 million 3/16 MC Kaiser
Contract - Conduct due diligence for WTHD Considers
Enhanced - Consider and provide input on possible operating 3.5 Million
structures for SRH moving forward.
Lender Requires:
-Change in Management Management Arrangement
-Funding Commitments Arrangements may be made by SRH for a assistance in Management
-County Negotiations Opened during the Stabilization and Evaluation Period
Notes:
Implementation
Time Line
St Rose Hospital Transitional
Authority January 2013
August 2012
SRH Board
HCSA
PWC Opens Short Term Operations and
Secures
Report Negotiations
Reviewed w ACMC and
1115 Funding Requirements
Waiver
Private
Funding
Operator
WTHD by 9/30
Releases SRH Partnership Evaluation
from LOI Evaluate Partnership Opportunities with Public and
Private operators
Explore New Partnership Reimbursable Advance
Gap Analysis Ongoing Operations
Opportunities
Short Term Funding Kaiser or Secured
Requirements Other IGT by
Approves 12/31
3 million by 9/30 (HCSA) 3.5 Million
3 million by 12/31 (System + IGT)
Management Arrangement
Arrangements may be made by SRH for a assistance in Management
during the Partnership Evaluation Period
Notes: SRH Continues
Implementation of HFS Study Implementation
and SRH Turnaround Plan Time Line
St Rose Hospital Transitional
Authority February
January 2013
2014
Continued
Secure
Parcel Implementation of Long Term Funding Picture
Additional
Measure Turnaround Plan
ongoing
Feasibility (operating
Public
efficiencies and
Subsidy
Revenue)
Initiate CSA
Secure Parcel Measure
Evaluate Partnership Opportunities with Public and
Private operators
Explore New Partnership Reimbursable Advance
Gap Analysis Ongoing Operations
Opportunities
Long Term Funding Sources of Ongoing Support
Requirements:
Parcel Measure or SNCP (4 million)
10 million annualized by Public Subsidy Enhanced (1 million)
February 2014
IGT (2.5 million)
Operating Efficiencies (1.0 million)
Revenue Enhancement (volume/contracts) (1.5 million)
TOTAL: 10 Million
Notes: SRH Gap analysis 8-12 million
Implementation
Time Line
